Concussion expert slams NHL's ‘hockey play’ excuses, CTE stance

PITTSBURGH, PA – MAY 1: Pittsburgh Penguins Center Sidney Crosby (87) skates off the ice with the Trainer Chris Stewart after getting a cross-checked by Washington Capitals defenseman Matt Niskanen (2) (not pictured) during the first period in Game Three of the Eastern Conference Second Round in the 2017 NHL Stanley Cup Playoffs between the Washington Capitals and the Pittsburgh Penguins on May 1, 2017, at PPG Paints Arena in Pittsburgh, PA. (Photo by Jeanine Leech/Icon Sportswire via Getty Images)

According to Chris Nowinski, the NHL can do more to help curb concussions in hockey.

While the league has taken some steps in the past year with concussions spotters’ ability to remove players to get examined, Nowinski, who is the co-founder and CEO of the Concussion Legacy Foundation, simply wants the NHL to admit that there’s a link between head injuries and the degenerative brain disease chronic traumatic encephalopathy (CTE).

Nowinski is also a co-founder for the Boston University CTE Center and has been a major proponent of better concussion activism in pro sports for years.

“Frankly the conversation about long-term effects in general has been misleading from the NHL, so I’ve been very disappointed in them,” Nowinski said.

In 2015, NHL commissioner Gary Bettman said in regards to head injuries and the correlation with CTE, “From a medical science standpoint, there is no evidence yet that one necessarily leads to the other.”

In 2016, when he was asked about comments from NFL senior vice president for health and safety Jeff Miller that a link between CTE and football had been established, Bettman noted the sports were different.

“I don’t think it’s even necessary or appropriate for me to comment on what the NFL either says or does,” he said. “Secondly, I think it’s fairly clear that playing hockey isn’t the same as playing football and as we’ve said all along we’re not going to get into a public debate on this.”

Part of the reason why Bettman won’t say there’s a link is because of a lawsuit brought on by former players about the NHL’s handling of concussions during their careers. .

Nowinski understands why the NHL won’t acknowledge the link, but sees this as an overall safety issue that impacts us as a society. Research has indeed shown several professional athletes in contact sports have gone on to develop CTE, but the prevalence is still unknown.

“We’re stuck in a place where they’re hurting public health by protecting their assets,” he said.

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In the last few weeks, there have been some incidents that have led to questions about the NHL, hockey culture and head injuries.

The Matt Niskanen cross-check of Penguins captain Sidney Crosby led to a concussion for Crosby and fresh worries about the superstar’s long-term health.

The return of Ottawa Senators forward Clarke MacArthur after he suffered four concussions over an 18-month span also led to some worry, considering earlier in the year, the Senators announced MacArthur wouldn’t play again this season citing doctors’ concerns.

We spoke with Nowinski about the NHL’s evolution in handling concussions, where he thinks the league can do better and his take on the definition of a “hockey play.”

Q: What’s your take on how the NHL is handling concussions? Is the league taking the right steps with spotters and such?

NOWINSKI: I expect a top sports league like the NHL to always be at the cutting edge and constantly staying on the cutting edge so any time they’re behind what other leagues are doing including the spotters’ ability to – having spotters every game and their ability to interact with the bench or players, any time you’re behind you’re in the wrong place. Those who can throw more resources at this problem need to. Frankly, the conversation about long-term effects in general has been misleading from the NHL, so I’ve been very disappointed in them.

By misleading, saying there’s no link between concussions from hockey and CTE?

They’re creating legally accurate statements that are misleading in the big picture, like there’s no evidence that concussions are correlated to CTE risk, which is true but there is evidence that repetitive brain trauma and exposure to contact sports is correlated to a CTE risk and that’s the problem. CTE is a bigger problem than people are willing to say and we need leadership from the top, not obfuscation.

But they can’t say it when there are a bunch of former players suing NHL over the league’s handling of concussions?

My understanding in talking with legal experts is that they simply cannot say that they believe there’s a link or else it will cost them in the lawsuit so we’re stuck in a place where they’re hurting public health by protecting their assets.

In your opinion, does the NHL’s denial impact the handling of concussions at younger levels of the game?

My understanding is the link between the NHL and, for example, USA Hockey is not nearly as strong as, for example, the NFL and USA Football. And I don’t believe in my interactions with USA Hockey that they’re taking their marching orders or medical advice from the NHL. They have their own independent experts who do take this seriously and have been working hard to change the game and did recently raise the age of checking partially in response to CTE concerns. I think the proactive steps of USA Hockey are minimizing the negative effects of the NHL’s statements. That being said, the average parent or average coach is more likely to hear the message from the NHL than any other organization within hockey. You can’t say that there’s not going to be a negative effect from belittling the risks that come with head impacts for children

The NHL is trying to police the game to limit concussions with the Department of Player Safety and concussion spotters, but meanwhile won’t acknowledge how head injuries lead to CTE. Is this double-speak from them to a degree?

Well, you can still police concussions aggressively if your only concern is post-concussion syndrome and players retiring with lingering symptoms from acute injury. You shouldn’t need CTE evidence to be aggressive with concussions and I will make that point for other sports that have a much lower risk of CTE but still have concussions. They should be just as aggressive on policing the game. Like for example, Major League Baseball banning collisions at home plate. They did that not because there’s been half a dozen Major League Baseball players diagnosed with CTE, but they did it because they don’t want players with post-concussion syndrome and they’re aware there’s things we still don’t know. So I guess that’s my answer.

There was something recently written citing a medical professional that Sidney Crosby shouldn’t play anymore because of his concussion history. What’s your take on this opinion, knowing you’re not treating him?

Part of the difficulty with concussions is it’s really hard to predict outcomes. So sometimes athletes will bounce back quickly, and other times they’ll have lingering symptoms that can go on forever. Generally the more concussions you have the easier they appear to get and they can tend to take longer to recover from but there’s no magic number of concussions that tells you when to retire or guarantees any sort of permanent symptoms. In terms of duration of this concussion – more recent studies have started to correlate what they call “symptom load” as being one of the better predictors of duration of symptoms so “how bad it was at the beginning. Was it just one symptom and was it mild or was it five symptoms and all were severe?”

But this is a tough place to be as an athlete where you have to wonder when you start feeling concussion symptoms, you have to wonder – we all know people who have never gotten better and you hope it’s not going to be you.

Something I find interesting is that we’re seeing signs of CTE in young athletes who stop playing at an earlier age. Crosby, for example, is 29 years old. This has to be scary to a degree. 

It’s a fair concern. With our initial hockey cases – most that had CTE, they were NHL players and they were primarily known as being fighters. Since boxing was the original sport that dealt with CTE, it made sense that maybe the boxing portion could be mostly responsible for that CTE. But recently Dr. Ann McKee revealed that we have four cases of young hockey players who never played in the NHL and all passed away before the age of 30 who all had early stage CTE and none were known as fighters, so that’s a concerning finding. We’ve always known that ice hockey can result in severe head impacts simply because you have athletes skating faster than they can run and running into the boards and falling on ice which are two of the hardest surfaces in sports. So ice hockey urgently needs more investigation.

A lot of people in the industry are calling it a “hockey play” that took out Crosby. What are your thoughts on people within the game calling it this?

(Laughs). If hockey plays are potentially ending the careers of the best hockey players, we need to redefine hockey plays. The reality is – all sports should continue to reform based on the new evidence on the effects of concussions and CTE so if we have to change the culture, if we have to suddenly call what used to be a cool hockey play and say “that’s not longer appropriate” then so be it. This conversation should be about what’s best for hockey players, not what’s best for the business of hockey.

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Again, understanding you don’t have medically specific knowledge on MacArthur, what’s your take on his return to the lineup? What should we think about a player having that many concussions in a short timespan returning? 

The reality of post-concussion syndrome is such an unknown disorder that we don’t know what’s causing long-term symptoms in specific individuals in most cases and sometimes those long-term symptoms have nothing to do with the brain or are fixable. For example there are a lot of people who deal with long-term headaches from neck injuries that go undiagnosed or are poorly rehabilitated, but that would be fixable. So you can’t always assume … it all depends on what they believe the cause is and what alleviated the symptoms. In some cases it could be appropriate to return and in other cases it may not be but you have to have specific information on the individual. In my mind not every case of longer-term post-concussion syndrome should result in retirement. Patrice Bergeron has shown you can have a successful career after a severe concussion that keeps you out for a year.

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Josh Cooper is an editor for Puck Daddy on Yahoo Sports. Have a tip? Email him at puckdaddyblog@yahoo.com or follow him on Twitter!

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